Intrauterine device insertion in the postpartum period: A systematic review

Objectives Given new research on postpartum placement of levonorgestrel and copper intrauterine devices (IUDs), our objective was to update a prior systematic review of the safety and expulsion rates of postpartum IUDs.Methods We searched MEDLINE, CENTRAL, LILACS, POPLINE, Web of Science, and ClinicalTrials.gov databases for articles between the database inception until July 2013. We included studies that compared IUD insertion time intervals and routes during the postpartum period. We used standard abstract forms and the United States Preventive Services Task Force grading system to summarise and assess the quality of the evidence.Results We included 18 articles. New evidence suggests that a levonorgestrel releasing-intrauterine system (LNG-IUS) insertion within 48 hours of delivery is safe. Postplacental insertion and insertion between 10 minutes and 48 hours after delivery result in higher expulsion rates than insertion 4 to 6 weeks postpartum, or non-postpartum insertion. Insertion at the time of caesarean section is associated with lower expulsion rates than postplacental insertion at the time of vaginal delivery.Conclusions This review supports the evidence that insertion of an intrauterine contraceptive within the first 48 hours of vaginal or caesarean delivery is safe. Expulsion rates should be further studied in larger randomised controlled trials. Chinese Abstract 摘要： 目的：鉴于有关产后放置左炔诺孕酮和铜制的宫内节育器（IUDs）的新研究，我们的目的是更新前一个关于产后宫内节育器的安全性和脱落率的系统综述。方法：我们检索了MEDLINE，CENTRAL，LILACS，POPLINE，Web of Science和ClinicalTrials.gov 数据库自建库到2013年7月的文章。我们收录的研究比较了产后放置宫内节育器时间间隔和途径。我们采用标准的抽象形式和美国预防服务工作组的分级系统来总结和评估证据的质量。结果：我们收录了18篇文章。新的证据表明，分娩后48小时内放置左炔诺孕酮宫内缓释系统（LNG-IUS）是安全的。分娩后10分钟到48小时内放置宫内节育器比产后4-6周或非产后放置宫内节育器具有更高的脱落率。剖宫产手术时放置宫内节育器的脱落率比阴道分娩产后放置的脱落率低。结论：本文支持的证据表明，阴道分娩或剖宫产分娩后48小时内放置宫内节育器是安全的。脱落率应需要更大的随机对照试验进一步研究。